Structuring flexibility: the potential good, bad and ugly in standardisation of handovers

摘要: Few strategies routinely used during shift change handovers in high-reliability organisations (HROs) are healthcare.1 The findings from the paper this issue by Borowitz et al 2 ( see page 6 ) add to growing empirical evidence that patient all healthcare settings highly variable content and process. Similar other respected researchers, authors recommend reducing variability, case standardising sign-out protocols. However, similar human factors I am concerned about potential unintended consequences well-intentioned approach. A natural experiment is already underway USA standardise handovers. This will likely be shaped these repeating patterns research complex socio-technical settings: In context of handover standardisation for care, predicted have positive impacts as well negative, consequences—in words, good, bad, ugly. Communication required safely transfer responsibility authority care a handover. Standardisation reduces cost communication because: